经皮冠状动脉介入治疗术后脑卒中患者的临床特征和预后分析  

Clinical characteristics and prognosis in the patients of stroke after percutaneous coronary intervention

作　　者：唐晓芳[1] 高展[1] 许晶晶[1] 宋莹[1] 马元良[1] 王欢欢[1] 姜琳[1] 蒋萍[1] 刘如[1] 高立建[1] 张茵[1] 宋雷[1] 陈珏[1] 杨跃进[1] 高润霖[1] 徐波[2] 袁晋青[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心脏病中心阜外医院心内科,北京100037 [2]中国医学科学院北京协和医学院国家心脏病中心阜外医院介入中心,北京100037

出　　处：《中华医学杂志》2017年第39期3051-3056,共6页National Medical Journal of China

基　　金：国家重点研发计划（2016YFC1301301）;国家自然科学基金青年基金（81600292）

摘　　要：目的探讨冠心病经皮冠状动脉介入治疗（PCI）术后随访期间发生脑卒中患者的临床特征及预后特点。方法选择阜外医院2013年行PCI的10724例冠心病患者，PCI术后随访2年，比较随访期间发生与未发生脑卒中的两组患者的临床特征和预后特点。结果共有145例PCI术后的冠心病患者发生脑卒中（1．4％），其中缺血性卒中124例（1．2％），4例（3．2％）患者死亡；出血性卒中21例（o．2％），9例（42．9％）患者死亡。与PCI术后未发生卒中的患者相比，发生脑卒中的患者女性比例较高，合并更多的临床危险因素（高血压、既往心肌梗死病史、既往脑卒中病史等）。2年随访结果提示，PCI术后发生脑卒中患者的全因死亡率明显高于未发生脑卒中患者（9．0％比1．1％；P〈0．0001），心源性死亡、心肌梗死、血运重建、支架血栓和主要不良心血管事件的发生率，两组患者之间差异无统计学意义。COX回归分析显示，PCI术后的脑卒中是全因死亡的独立危险因素（HR=8．387，95％CI：4．725～14．855，P〈0．0001），倾向性评分调整后，上述趋势没有变化，PCI术后的脑卒中仍是全因死亡的独立危险因素（HR=6．737，95％CI：1．52～29．85，P=0．012）。结论PCI术后发生脑卒中的冠心病患者，合并更多的临床高危因素，并且动脉粥样硬化的程度更重。PCI术后2年随访期间发生的脑卒中是冠心病患者全因死亡的独立危险因素。Objective To investigate the clinical characteristics and prognosis in patients with stroke after percutaneous coronary intervention （PCI）. Methods From January 2013 to December 2013, 10 724 consecutive patients undergoing PCI including acute coronary syndrome and stable angina pectoris were enrolled. A two years＇ follow up was conducted among these patients to investigate the clinical characteristics and prognosis of patients with stroke and of those without. A comparison was done between the two groups. Results One hundred and forty-five patients had stroke （ 1.4% ） during the follow-up period after PCI, including 124 cases with ischemic stroke （1.2%）, out of whom 4 （3.2%） patients died; 21 cases with hemorrhagic stroke, out of whom 9 patients （42. 9% ） died. There was more female, and more patients with risks factors, hypertension, previous myocardial infarction, previous stroke, etc. in the patients with stroke. During the 2-year follow-up, patients with stroke experienced higher incidence of all-cause mortality （9% vs 1.1% , P 〈0. 000 1 ）. There were no significant differences in the incidences of cardiac death, myocardial infarction, revascularization, stent thrombosis and major adverse cardiovascular event rates between the two groups. COX regression analysis showed that stroke after PCI was associated with the increased mortality （HR = 8. 387, 95% CI：4. 725 - 14. 855, P 〈 0. 000 1 ）. Meanwhile, after propensity score matched analyses （129 pairs） , the trend was not changed, and stroke was still an independent risk factor of all-cause mortality （ HR = 6. 737, 95% CI： 1.52 - 29. 85, P = 0. 012）. Conclusions The patients underwent PCI, who had stroke later, had more clinical risk factors, and more serious degree of atheroselerosis. The incidence of stroke is an independent risk factor for all-cause mortality in patients with coronary heart disease after PCI.

关 键 词：冠心病 经皮冠状动脉介入治疗 脑卒中 临床预后 

分 类 号：R541.4[医药卫生—心血管疾病] R743.3[医药卫生—内科学]